By: James Romanelli, MD

Sizing is one of the most important decisions that patients who are considering breast implants on Long Island have to make, but a new type of adjustable implant might help patients take some of the “guesswork” out of their choice by letting them add or subtract a little volume after surgery.

In most cases a cosmetic breast surgery patient on Long Island will spend enough time with her surgeon evaluating the different options before surgery so that she is very pleased with the results. However, some patients like the idea of having the flexibility to tailor their results after surgery if they would like a slightly smaller or larger breast size.

What you need to know about adjustable implants:

What’s the Difference?

The typical breast augmentation surgeon offers both saline and silicone-gel breast implants. Long Island women choose silicone-gel implants for their more natural shape and feel, but this implant type comes pre-filled and the size cannot be adjusted after surgery. Similarly, saline implants can be filled very precisely during surgery, but after surgery their volume cannot be adjusted further. For a woman choosing either of these traditional implant types, breast revision surgery is required if a smaller or larger breast size is desired after surgery.

The new adjustable gel implants combine advantages of both types of implants by placing a smaller saline implant within a larger silicone-gel implant. The surgeon places the implant normally and fills the inner saline implant to the level decided upon before surgery. If within the first month the patient wants to adjust her volume, the surgeon can add or remove saline through a valve that is itself removed once the patient is happy with her breast size.

Possible Advantages

These implants are currently under clinical review and are not offered by very many surgeons. Even so, early studies suggest they might offer a few advantages:

• Limiting scarring: Some studies suggest that by allowing the surgeon to overfill the implants initially, then reduce the volume after the implant pocket has begun to heal, these implants could help limit the risk of severe capsular contracture (thick scar tissue around the implant).
• Greater confidence in breast surgery results: Long Island patients who receive these implants might find it reassuring to know that they have the freedom to rethink their choice of size, taking some of the uncertainty out of the healing process.

My Perspective

I prefer to evaluate new technologies thoroughly before offering them to my patients, and while these new implants may have some benefits, they do not have the track record of success to allow me to feel comfortable offering them to my breast surgery patients from Long Island. At the same time, so many other breast implant considerations are just as important to a patient’s ultimate happiness with her outcome, including implant type, projection, base width, placement, and choice of incision site, to name a few.

There is an art and a science to helping patients choose a size that will look natural on their shape. In the end, I think most patients would benefit most from taking the time to choose a surgeon who emphasizes natural results and careful planning, and offers specific approaches and post-surgical treatments to help prevent scarring in the first place, rather than relying too heavily on technology to “solve” one of the many challenges of this type of procedure.

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